YETI score, useful tool for predicting recovery after iatrogenic cryoballoon-related PNI: Circulation

Published On 2022-01-19 03:30 GMT   |   Update On 2022-01-19 03:30 GMT

Germany: Phrenic nerve injury (PNI) is the most common complication that occurs during cryoballoon-based pulmonary vein isolation (PVI). Now, the latest study published in the journal Circulation: Arrhythmia and Electrophysiology has found that the incidence of PNI during the procedure to be 4.2%. Within 12 months, 97% of PNI recovered. Further, symptomatic and permanent was shown to...

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Germany: Phrenic nerve injury (PNI) is the most common complication that occurs during cryoballoon-based pulmonary vein isolation (PVI). Now, the latest study published in the journal Circulation: Arrhythmia and Electrophysiology has found that the incidence of PNI during the procedure to be 4.2%. Within 12 months, 97% of PNI recovered.

Further, symptomatic and permanent was shown to be exceedingly rare in patients following cryoballoon-based PVI. Prognosis can be estimated by YETI score after atrogenic cryoballoon-derived PNI, the authors noted.

"YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months," Christian-H. Heeger and the team from Germany wrote in their study. 

Cryoballoon-based pulmonary vein isolation is an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury. However, there is not much data on PNI. 

The YETI registry is a retrospective, multinational, and multicenter registry that evaluates the incidence, characteristics, prognostic factors for PNI recovery, and follow-up data of patients with PNI during cryoballoon-based PVI. It included patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI. 

A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 17 countries. 

The study revealed the following findings:

  • A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was −49±8 °C.
  • At the end of the procedure, PNI recovered in 394/731 patients (53.9%).
  • Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up).
  • A total of 16/703 (2.3%) reported symptomatic PNI.
  • Only 0.06% of the overall population showed symptomatic and permanent PNI.
  • Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol.
  • Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery.
  • Based on these parameters, a score was calculated.
  • The YETI score has a numerical value that will directly represent the probability of a specific patient recovering from PNI within 12 months.

"We found the incidence of PNI during cryoballoon-based PVI to be 4.2%," wrote the authors. "Overall 97% of patients affected by PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI."

Reference:

The study titled, "Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry," was published in the journal Circulation: Arrhythmia and Electrophysiology. 

DOI: https://doi.org/10.1161/CIRCEP.121.010516

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Article Source : Circulation: Arrhythmia and Electrophysiology

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